To determine the efficacy of advancing to triple or quadruplemedical therapy in glaucoma patients.

Methods:

A retrospective chart review of glaucoma patients who were advancedto three or four ocular hypotensive medications between 2006and 2010. Baseline IOP and Humphrey Visual Field (HFA) datawere collected up to 12 months before advancing therapy. Afteradvancing therapy IOP measurements were recorded every threemonths up to 15 months; HFA data was collected for up to 15months.

Results:

Of the 155 patient charts reviewed, 95 met the inclusion criteria(at least 18 years of age and on < 4 medications). 62 patientswere placed on a 3rd medication, 33 on a 4th medication. Ofthe 63 patients on a 3rd medication, 23 were later placed ona 4th medication. After addition of a 3rd medication, IOP reductions(p<0.05) were observed for at least 12 months. 17.7% of tripletherapy and 25.0% of quadruple therapy patients required glaucomalaser or surgery. Fourteen (22.6%) patients on three medicationsand 13 (23.2%) patients on four medications were lost to follow-up.The mean deviation (MD) before advancement in therapy was -6.52±6.22dB (N=36) and -7.64± 6.92 dB (N=21) for triple and quadrupletherapy patients respectively. Mean MD was unchanged over 15months.

Conclusions:

Advancement to triple glaucoma drug therapy was associated witha significant reduction in IOP for up to 12 months, and canbe considered as a treatment option in patients needing additionalIOP reduction. The addition of a fourth drug appears to havea limited effect on IOP.